This week in Washington—the Kaiser Commission on Medicaid and the Uninsured released an analysis on uninsured poor adults in states not expanding their Medicaid program. You are tuning in to the health policy update from America’s Essential Hospitals for the week of Oct. 21.
An Oct. 16 analysis from the Kaiser Commission on Medicaid and the Uninsured estimated that 5.2 million uninsured poor adults living in states not expanding their Medicaid program will fall into a so-called “coverage gap.” These uninsured adults have incomes too high to be eligible for Medicaid, but too low to be eligible for financial assistance to help them buy health insurance through the marketplaces. For example, in Texas, parents with incomes between 19 and 100 percent of the federal poverty level will fall into the coverage gap.
So far, 26 states have chosen not to expand their Medicaid program. The analysis estimated that more than a quarter of the people who are uninsured in these states will fall into the coverage gap. Many of the people who will fall into the coverage gap live in a few large states with high numbers of people who are uninsured. For example, 20 percent live in Texas, 15 percent live in Florida, and 8 percent live in Georgia.
People who fall into the coverage gap will have few, if any, affordable options for buying health insurance and will likely remain uninsured. For example, the analysis estimated some people who will fall in the coverage gap would have to spend as much as half of their incomes on bronze or silver premiums if they chose to be covered. On top of that, these plans require higher out-of-pocket costs than Medicaid, which further increases cost to the consumer. As a result, marketplace plans are just too expensive for people who fall into the coverage gap.
The analysis concluded that the coverage gap is significant for both consumers and providers. For consumers, it means those who fall into the coverage gap will face barriers accessing affordable insurance coverage. For providers, it means hospitals and clinics serving high volumes of uninsured patients will continue to be stretched thin, especially in states with high numbers of low-income people who are uninsured.
Thanks for listening to another edition of This Week in Washington. I’m Erin Richardson; join us next week for another health policy update.